Orthostatic Blood Pressure

Hello everyone!
I found this site last weekend during a very slow night shift, (I'm in no way complaining about this fact!!) I found a lot of interesting info and am hoping that someone can help me!
I work in L&D and we frequently treat hyperemesis patients. There has been much discussion about the correct way to check orthostatic blood pressure on these patients. I know that you check HR/BP while the patient is supine, then sitting, then finally standing. What I need to know is, how long do you wait after each position change to check the HR/BP? And how do you use these different sets of VS to determine if the patient is orthostatic?
I would appriciate any info that anyone can pass along. If anyone knows of any websites that has this info, please let me know this too! Thank you in advance!

Generally wait 3-5 minutes after each position change before you check the BP/HR.

A person is said to be postural (or orthostatic) if their SBP drops more than 15-20 mmHg. Also, you would expect their pulse to go up.

For example, if someone sitting is 140/89 and then is 109/82 when standing, they are indeed orthostatic.

May 7, '06

Quote from zacarias

Generally wait 3-5 minutes after each position change before you check the BP/HR.

A person is said to be postural (or orthostatic) if their SBP drops more than 15-20 mmHg. Also, you would expect their pulse to go up.

For example, if someone sitting is 140/89 and then is 109/82 when standing, they are indeed orthostatic.

Also check for dizziness with position changes. If a person is truly orthostatic, they will usually feel dizzy and/or about to pass out with position change, especially when standing. Some do not of course, but as a general rule, dizziness with position change accompanies a postural patient.

May 7, '06

I may be waaaayy wrong for this, but I don't see how waiting 3-5 minutes is accurate. I had to take a lot of orthostatics in the office setting and we all were taught to check the BP and pulse as soon as the position was changed. If you waited that long, wouldn't the BP normalize?

May 7, '06

Quote from southernlpn

I may be waaaayy wrong for this, but I don't see how waiting 3-5 minutes is accurate. I had to take a lot of orthostatics in the office setting and we all were taught to check the BP and pulse as soon as the position was changed. If you waited that long, wouldn't the BP normalize?

I'll be honest and say that I'm not sure what the literature indicates. Our renal docs order orthostatics to be taken at 5 minute intervals.

May 7, '06

Quote from southernlpn

I may be waaaayy wrong for this, but I don't see how waiting 3-5 minutes is accurate. I had to take a lot of orthostatics in the office setting and we all were taught to check the BP and pulse as soon as the position was changed. If you waited that long, wouldn't the BP normalize?

I agree. I was always taught to check it as soon as they are in the new position.

I was an a med that caused me orthostatic hypotension, to the point where I'd get so dizzy sometimes I'd fall (only happened about 3 times, but still scary!), and many times I'd see spots, etc. By 5 minutes, my BP had normalized. Had the nurse waited that long to take my bp, it would have looked like there was nothing medically wrong with me...or would have led to more un-necessary, possibly invasive tests....
Kelly

May 8, '06

The reference I found states that it is defined as a drop in SBP of 20 or decrease of 10 mm diastolic, also and increase in hr of 20 beats per minute. Some references state these things occur within 3 minutes of standing. I have heard the debate for both. Will have to check the ole nursing textbook to be sure of correct procedure. I am sure when our NA's obtain orthostatics, they arent waiting 3-5 minutes between each reading.

May 8, '06

Always been my understanding that a healthy "normal" person can drop a little bit in pressure when they stand up. As a normal practice in our ED we wait at least 1-3 min between BP's and P's. If a pt is truely orthostatic they will still be low after the 3-5 min as previously discussed.

May 8, '06

I wait one minute between checks and haven't had any trouble with false positives. I have found that the truly orthostatic need to sit down or puke if you keep them up any longer, and then the doc will ask me to stand them again, and get the blood pressure (DUH!)

May 8, '06

Looking at the studies and sources available online, it's a wonder that any of us are doing orthostatic vital signs the same way. Each reference seems to have its own recommendations regarding orthostatics. One says wait two minutes after changing, another says one minute to three minutes. Some sources even say not to worry about the set of sitting vitals, skipping straight to standing.

I found the article below which makes a good point - that orthostatics pose a risk of injury and are really only super accurate in patients who are too sick to safely have the test anyway.

This is a subject near and dear to my heart, as I gave myself a concussion and nasty laceration (requiring five staples to the occiput) while I was in the 'Jello phase' recovering from a wisdom tooth extraction a year ago. Stood up abruptly one too many times and tilted myself. In case you're wondering, my completely anecdotal experience was that the biggest decrease in BP occurs at about ninety seconds to two minutes.

May 8, '06

Our rule is check BP/HR 2 minutes after the position change. A 'normal' person will have compensated by this point. Our folks are considered orthostatic with a drop in SBP of 10 or more and an increase in HR of 10 or more.